ATI PHARMACOLOGY NSG 1540 EXAM 3
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Free ATI PHARMACOLOGY NSG 1540 EXAM 3 Questions
A client receiving azathioprine (Imuran) asks why frequent blood tests are required. What is the nurse's best response?
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"The tests evaluate whether the drug is causing bradycardia."
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"This medication can cause severe dehydration."
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"The tests help monitor for kidney stones."
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"We are checking for bone marrow suppression."
Explanation
Correct Answer: D) "We are checking for bone marrow suppression."
Azathioprine is an immunosuppressant that works by inhibiting purine synthesis, thereby suppressing the proliferation of immune cells. A major and serious adverse effect is bone marrow suppression — leading to leukopenia, thrombocytopenia, and anemia — which significantly increases the patient's risk of life-threatening infections and bleeding. Regular complete blood count (CBC) monitoring is essential to detect early signs of myelosuppression so that the dose can be adjusted or the medication discontinued before severe complications develop.
Azathioprine does not cause bradycardia, severe dehydration, or kidney stones — these are not recognized adverse effects of this medication and therefore do not explain the need for routine blood monitoring.
Which statement should a nurse include when teaching a parent about the safe use of medications for a child who has an illness causing a fever?
- "Alternate aspirin and ibuprofen to control fever more effectively."
- "Avoid giving aspirin because it increases the risk for Reye's syndrome."
- "Use aspirin only if the child has a high fever that does not respond to acetaminophen."
- "Give aspirin with food to reduce the risk of stomach upset."
Explanation
Correct Answer: B) "Avoid giving aspirin because it increases the risk for Reye's syndrome."
Aspirin is contraindicated in children and adolescents with viral illnesses due to its strong association with Reye's syndrome — a rare but life-threatening condition involving acute liver failure and brain swelling. The exact mechanism involves aspirin interfering with mitochondrial function in the setting of certain viral infections such as influenza and varicella. Parents must be clearly educated that aspirin should never be given to children with febrile illnesses, and that acetaminophen or ibuprofen are the safe, recommended alternatives for pediatric fever management.
Alternating aspirin with ibuprofen is dangerous and absolutely contraindicated in children. There is no safe threshold of aspirin use in febrile children — it should be avoided entirely regardless of fever severity. Giving aspirin with food does not eliminate the risk of Reye's syndrome, making this instruction misleading and unsafe.
Provider's order says: 100 mL Ceftriaxone Sodium 1G to infuse over 30 minutes. What is the hourly rate?
Explanation
Correct Answer: 200 mL/hr
Using the formula: Hourly rate = Total volume ÷ Time in hours 100 mL ÷ 0.5 hours = 200 mL/hr Since the infusion is ordered over 30 minutes (0.5 hours), the IV pump must be set to deliver 200 mL per hour to administer the full 100 mL within the specified time frame.
A nurse is reviewing the chart of a client who developed red man syndrome during vancomycin therapy. Which factor should the nurse identify as the most likely cause of this reaction?
- Administering the medication through a central venous catheter.
- Administering the medication intramuscularly.
- Administering the medication with a high-protein meal.
- Infusing the medication too rapidly.
Explanation
Correct Answer: D) Infusing the medication too rapidly.
Red man syndrome is a non-allergic infusion-related reaction caused by rapid infusion of vancomycin, leading to histamine release. It presents with flushing, erythema, and pruritus typically over the face, neck, and upper torso. It is prevented by infusing vancomycin slowly over at least 60 minutes. The route of administration (central line or IM) and food intake are not associated with red man syndrome.
A nurse is preparing to administer a vaccine to an adult client. Which conditions should cause the nurse to delay giving a live vaccine? (Select All that Apply.)
- Age older than 60 years
- Pregnancy
- Use of corticosteroids
- Recent chemotherapy
- History of allergies
Explanation
Correct Answer: B) Pregnancy, C) Use of corticosteroids, D) Recent chemotherapy
Live vaccines contain weakened but viable pathogens and are contraindicated in individuals with compromised immune systems or in pregnancy. During pregnancy, live vaccines pose a risk of crossing the placenta and potentially harming the fetus. Corticosteroids suppress immune function, and administering a live vaccine during immunosuppressive therapy could cause the attenuated pathogen to replicate uncontrollably, leading to infection. Recent chemotherapy significantly depletes immune cells, making the patient unable to safely respond to a live vaccine and at risk for vaccine-induced disease.
Age older than 60 years is not a contraindication — several live vaccines such as the shingles vaccine are actually recommended for this age group. A general history of allergies alone does not contraindicate live vaccines unless there is a specific known allergy to a vaccine component, which would require further evaluation before administration.
A nurse is assessing a client receiving treatment for active tuberculosis (TB). Which finding requires immediate intervention?
- Nonproductive cough
- Weight loss of 2 lb in 1 week
- Yellow discoloration of the sclera
- Positive sputum culture after 3 weeks of treatment
Explanation
Correct Answer: C) Yellow discoloration of the sclera.
Yellow discoloration of the sclera (jaundice) indicates hepatotoxicity, a serious and potentially life-threatening adverse effect of first-line TB medications, particularly isoniazid, rifampin, and pyrazinamide. This requires immediate intervention including discontinuation of the offending drug and prompt medical evaluation. A nonproductive cough and mild weight loss can be expected during TB treatment. A positive sputum culture at 3 weeks is not immediately alarming as sputum conversion typically occurs within 2–8 weeks of treatment.
A nurse is evaluating the effectiveness of allopurinol therapy for a client who has chronic gout. Which laboratory finding indicates the medication is achieving the desired therapeutic effect?
- White blood cell count of 11,000/mm³ (Reference range: 4,000–11,000/mm³)
- Serum creatinine level of 1.4 mg/dL (Reference range: 0.6–1.2 mg/dL)
- Serum uric acid level of 5.8 mg/dL (Reference range: 3.5–7.2 mg/dL)
- Blood glucose level of 130 mg/dL (Reference range: 70–110 mg/dL)
Explanation
Correct Answer: C) Serum uric acid level of 5.8 mg/dL (Reference range: 3.5–7.2 mg/dL)
Allopurinol works by inhibiting xanthine oxidase, thereby reducing the production of uric acid. A serum uric acid level within the normal reference range indicates the medication is achieving its therapeutic goal of preventing hyperuricemia and gout attacks. A normal WBC count does not reflect allopurinol's effect. An elevated creatinine suggests possible renal impairment, which is a concern with allopurinol use, not a therapeutic effect. An elevated blood glucose is unrelated to allopurinol therapy.
A nurse is teaching a client about ibuprofen. Which of the following cues should the nurse recognize as a potential complication of ibuprofen?
- Black, tarry stools
- Yellowing of the skin
- Decreased blood pressure
- Increased appetite
Explanation
Correct Answer: A) Black, tarry stools
Black, tarry stools (melena) indicate gastrointestinal bleeding, which is a serious and well-known complication of ibuprofen and other NSAIDs. NSAIDs inhibit prostaglandin synthesis, which normally protects the gastric mucosa, making GI bleeding a significant risk. Yellowing of the skin suggests hepatotoxicity, more commonly associated with acetaminophen overdose. Decreased blood pressure and increased appetite are not recognized complications of ibuprofen use.
A nurse is preparing to administer penicillin G to a client. The client reports a history of a rash after receiving amoxicillin. Which action should the nurse take?
- Ask the client to describe the rash and proceed if it was mild
- Administer the medication and monitor for a reaction
- Document the allergy and give the medication with diphenhydramine
- Notify the provider before administering the medication
Explanation
Correct Answer: D) Notify the provider before administering the medication
Amoxicillin is a penicillin-class antibiotic, and a reported rash following its use may indicate a penicillin allergy. Since penicillin G belongs to the same beta-lactam antibiotic class, cross-reactivity is a significant concern. Before administering any medication from the same drug class to a client with a possible allergic history, the nurse must notify the provider to evaluate the allergy, determine its severity, and decide whether to proceed, substitute an alternative antibiotic, or conduct allergy testing. Patient safety takes priority over proceeding with administration.
Asking about the rash and proceeding based on severity bypasses the required provider consultation and places the patient at risk. Administering the medication and monitoring is unsafe given the potential for cross-reactive anaphylaxis. Giving diphenhydramine prophylactically does not adequately protect against a severe allergic reaction and is not an appropriate independent nursing action in this situation.
A nurse is teaching a client about the signs of salicylate toxicity while taking aspirin therapy. Which client statement indicates an understanding of the teaching?
- "If I start hearing ringing in my ears, I should notify my provider."
- "I should ignore any side effects as long as the medication helps my pain."
- "I should expect my breathing to slow down slightly while on aspirin."
- "Aspirin toxicity usually causes constipation, so I'll increase my fiber intake."
Explanation
Correct Answer: A) "If I start hearing ringing in my ears, I should notify my provider."
Tinnitus — ringing in the ears — is one of the earliest and most classic signs of salicylate toxicity, occurring when aspirin blood levels become excessive. Recognizing this symptom and promptly reporting it to the provider allows for timely intervention before toxicity progresses to more serious manifestations such as hyperventilation, metabolic acidosis, altered mental status, and cardiovascular collapse. This statement demonstrates correct understanding of the teaching.
Ignoring side effects is dangerous and directly contradicts safe medication practice. Aspirin toxicity causes increased respiratory rate (hyperventilation), not slowed breathing, as the body attempts to compensate for metabolic acidosis. Salicylate toxicity is associated with nausea, vomiting, and diarrhea — not constipation — making increased fiber intake an inappropriate and misleading response.
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